Management of Chronic sinusitis at Columbia Asia January 12 2017

Many of the things I have learnt from management of Chronic Sinusitis:

The indication of surgery in my case was failure of medical treatment and also my congenital defect from my past cleft lip surgery Plus failure to eradicate the infection as assessed persistent tenderness of left frontal sinus and still completely free of bad odor in my nostrils and taste in my mouth plus CT scan of sinuses showing marked opacity of left sinuses all of them.  Right looked ok. I had two weeks of Augmentin 1 gm per day and Levofloxin 500 mg daily and this did not completely eradicate the infection. I was admitted after I had preop blood tests which included earlier done blood sugar and currently Complete Blood count Blood group at my request but not necessary, lytes Creatinine and Serology as requested by Dathathri which ruled out HIV hepatic B like that and complete cardiac work up like Treadmill, Echo EKG and it was clearly I needed to get that and luckily I am healthy cardiac wise.  The surgery was done in the morning Actually no instructions were given to me pre op things I should do not do by the doctor and I learnt the latest one on the internet which frowns on nothing my mouth after midnight, encourages fluid excepting dairy products which could act like slowly digesting solid food because of heavy fat content and I could drink water almost till 2 hours before surgery I did take sips of water till I left home. I was admitted to the floor. I had no idea of cost of the one day admission nursing care and surgical care. I paid 40000.00 deposit and this is what Dathathri told me to do and my final payment was another 25000.00 which included all the cost of surgery nursing and room rate a beautiful special single bed with excellent nursing care and even food was good.  My surgery started at 9:00 am and lasted for 2 hours Hourly messages were sent from Operating room to the listed Mobile numbers that is mine and Rajendra. I did not realize that the reception why they insisted on my contact number. After surgery I was visited by Ammanna and others and Dathathri I was half conscious and did not know it.  Latter on I was awake and wheeled out of the operating room I was given IV Pentothal and intubated. I never felt or knew about intubation and my throat on the right side was bit sensitive to warm liquids for a day because of that. I had no pain did not need any pain medications although nursing staff gave me Paracetamol three times.  I had a round bulb like dressing on my nose taped and it was liquid and air tight did not allow any leakage. I started noticing bloody blood discharge next day when the dressing was removed. The night of surgery at the hospital was kind of restless because of no proper comfort in the bed and discomfort of the nasal area. I was starved of any food and liquids almost till 3:45 pm and started taking coconut water and a 2 liter bottle of Aquafina left bedside. I had egg sandwich in the evening coffee and  night had a supper rice Rasam curds vegetable cooked and some cut fruits.  Next day I was ready to get out. Dathathri with his assistant Praveen with another lady person visited me in the evening and had discharged me in the morning Since I am a cash payer no insurance my discharges were easy I had to wait for driver Murali to give me the ATM which Ammanna had taken with her in spite of my request to leave it with me.  I got picked up around 9:00 am by Murali and Ammanna. Nursing staff was very nice friendly I felt like I was a special patient. Home and I have been improving. First night at home was not as good as second night and today is 3^rd day and I am almost normal.

What is Endoscopic Sinus surgery?

Endoscopic Sinus Surgery is a surgical procedure to remove unhealthy sinus tissue from the drainage channels, which helps in making way for the drainage of infected material from the sinus cavities. The surgery is mostly performed using endoscopic methods for improved and accurate view. Endoscopic nasal sinus surgery is done without external incisions and therefore there is very little bleeding, swelling and discomfort, which enables a fast recovery. Endoscopic sinus surgery does not damage healthy tissues, requires less time and yields good results. Nasal sinus surgery requires post-operative care, therefore follow-up and aftercare should be given essential attention.

How is Endoscopic Sinus Surgery performed?

A nasal endoscope is inserted through the nostrils into the nasal cavity. This allows the doctor to view the inside of the nose and sinuses.

The middle turbinate is located to identify and remove the uncinate process.

The ethmoid air cells are opened to improve ventilation, leaving the bone with the covering of mucous membrane.

Any blockage in the ostium, situated close to the jaw is removed with a meatal antrostomy.

The surgery helps to improve the ventilation of the sinuses by making the osteomeatal complex function better.

How to prepare for the Endoscopic Sinus surgery?

The patient’s medical history is reviewed by the doctor.

An ENT specialist will conduct diagnostic examination on the patient, which may involve fiberoptic endoscopy and CT scan.

The patient needs to avoid taking certain medication that may worsen bleeding. This includes herbs and vitamins.

The patient may be required to take antibiotics and steroids to reduce swelling.

Patients who smoke are advised to stop or reduce smoking to help in recovery.

The doctor should be informed if the patient has fever or any illness before the surgery.

Duration of procedure/surgery :

60 to 90 minutes

Days admitted :

Nasal sinus surgery is usually done as an outpatient procedure.

Anesthesia :

Local anesthesia with intravenous sedation

Recovery :

- The patient is taken to the recovery room where the patient’s vital signs are monitored.

- Moderate bleeding from the nose after the surgery is normal.

- The patient may vomit once or twice after the surgery.

- Swelling of the nose, around the eyes, and upper lip is noticed for several days.

- Complete recovery may take three to five days.

Risks :

- Injury to the optic nerve, resulting in blindness

- Leakage of cerebrospinal fluid

- Orbital Hematoma

- Nasolacrimal duct stenosis

- Intracranial injury

- Smell and taste impairment

- Numbness

- Voice change

- Pain

- Nasal blockage

After care :

- The patient will not be able to drive after the surgery due to drowsiness and disorientation.

- The nose dressing should be changed regularly as it becomes wet.

- The patient may need to wear a nose pack for a few days

- The patient should avoid blowing the nose for about a week from the surgery.

- The patient should sleep with the head at an elevation.

- Pain medication should be taken only after consulting the doctor.

- The patient may need to use a saline spray for six to eight times a day to keep the nose moist.

- The patient should restrain from strenuous activities and physical recreational activities for a few weeks.

- Alcoholic beverages, caffeine, and spicy food should be avoided.

- Decongestant nasal sprays should not be used without consulting a doctor.

- Dairy products may cause excessive mucous formation and should therefore be avoided.

(Myth Buster: Milk consumption does not lead to mucus production or asthma.

The belief has been held for years that milk causes mucus formation, although the few studies on this topic have failed to demonstrate any effect of milk on mucus production. Many people confuse the temporary, slight thickening of saliva after drinking milk with mucus. There is no scientific research showing that milk produces mucus in the airways or the throat. It will not worsen cold or asthma symptoms. In fact, although many people reduce milk intake when they have a cold, one clinical trial showed milk and dairy food intake was not associated with an increase in upper or lower respiratory tract symptoms of congestion.1 Studies have found milk intake was not associated with increased nasal secretions, coughing, nose symptoms or congestion.2,3 Some doctors say that milk thickens saliva, which may coat the throat and give the perception of more mucus, but it does not cause the body to produce more mucus or phlegm.

Furthermore, milk may actually contribute to speeding up recovery, as drinking lots of fluids when you have a cold is important. Frozen dairy foods and fruit smoothies may soothe a sore throat and provide important calories and nutrients when you are not eating much else.)

- The patient should avoid smoking and should drink a lot of water.

- The patient should take all medication prescribed by the doctor.

- A follow up appointment is scheduled a week after the surgery.

My Discharge instructions are as follows;

Avoid Nose Blowing/ Sneezing

·       Avoid Distant Travel

·       Avoid Dust and Smoke

·       Steam inhalation Daily twice for 15 min each time

·       Plenty of Oral Liquids

·       Report to Emergency ROOM if any bleeding from nose/ mouth/ Headache/ Fever

PARACETAMOL TAB 650 MG DOLO-650

Dosage: 1 TABLET' Frequency: 3 TIMES A DAY' Duration: 3 Days Route : PER ORAL 1 Drug Instruction : 1 Special Instruction :

Montelukast + Fexofenadine hydrochloride 10mg+120mg Tablet Montair FX Dosage: 1 TABLET' Frequency: 0-0-11 Duration: 5 Days

Route : PER ORAL 1 Drug Instruction : 1 Special Instruction :

XYLOMETAZOLINE DROP 0.1% W/V OTRIVIN - ADULT NASAL SPRAY 10ML Dosage: 3 DROPS' Frequency: 3 TIMES A DAY1 Duration: 5 Days

Route : INTRANASAL 1 Drug Instruction : 1 Special Instruction :

LEVOFLOXACIN TAB 500 MG LEVOFLOX

Dosage: 1 TABLETI Frequency: 0-1-01 Duration: 10 Days Route : PER ORAL 1 Drug Instruction : 1 Special Instruction :

AUGMENTIN DUO 1000MG TABLET(AMOXYCILLIN+CLAVULANATE 875MG+125MG)GSK Dosage: 1 TABLETI Frequency: 1-0-11 Duration: 5 Days

Route : PER ORAL 1 Drug Instruction : 1 Special Instruction :

Follow up /appointment :

Review after 4 Days with Dr. Dathathri prior appointment

Actual surgical procedure done on me by Dr. Dathathri

Surgeries Performed

Total charges	₹74,996.25
Consultation medications and preoperative tests blood CT scan and Cardiac approximate cost	₹10,000.00
Surgical Supplies	₹3,347.50
Pharmacy	₹11,567.02
Doctor charges	₹28,441.10
Hospital Charges	₹21,640.63

Surgery Date: 12/01/2017 I Performed By: DATHATHRI.H I Surgery: Septoplasty with FESS for Left side done

under GA I I Surgical Prophylaxis I I Septoplasty done to correct Gross Bony + Cartilagenous DNS I Left

Uncinectomy+ Middle meatal antrostomy+ Anterior and posterior ethmoidectomy+ Sphenoidotomy+ Frontal

Sinusotomy done I I Hemostasis achieved by packing I Gel foam with triamcinolone packing done I I Post Op

Vision/ Reflexes/ Vision- Normal I

Cost of management including everything